Provider Demographics
NPI:1366579013
Name:MARCELLUS R CEPHAS MD LLC
Entity type:Organization
Organization Name:MARCELLUS R CEPHAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCELLUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CEPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-2077
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-2077
Mailing Address - Fax:301-891-2080
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAKOMA PK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-891-2077
Practice Address - Fax:301-891-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00595532103TP2701X, 2084P0800X
MD207888-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH022891Medicaid
MD4022891Medicaid
MDH022891Medicaid
MD00B830M02Medicare ID - Type UnspecifiedMEDICARE
MD00B83QM02Medicare PIN
MDG01202Medicare PIN